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Abstract

Epirubicin is a potent and widely used citotoxic drug, but its application is often limited by the cumulative dose-dependent cardiotoxicity. LV ejection fraction (EF) and fractional shortening (FS) are the most commonly used indices to demonstrate cardiac dysfunction. Since normal EF or FS can mask significant LV impairment, we hypothesized that LV systolic torsion and deformation represent better markers of epirubicin-induced subclinical cardiac dysfunction.

Results: No changes in LV dimensions, EF, and FS were observed during follow-up. However, there were significant reductions in RotA, and consequently in LVT and LVTR, with no changes in RotB; and also a significant decrease of LV radial and longitudinal deformation found after the first cycle of epirubicin and persistent after the sixth cycle (see table). Univariate analysis showed that epirubicin cumulative dose was directly correlated with longitudinal strain and LV twist reduction after 6 months of treatment (r=0.59 and r=0.79; both p<0.01).